Objective: To determine whether the addition of manual diaphragm release to an inspiratory muscle training programme is more effective than inspiratory muscle training alone in reducing blood pressure, dyspnoea, fatigue, and aerobic performance capacity in men with post-COVID-19 syndrome.Design: A prospective, randomized-controlled trial.Setting: Chest Disease Department, Outpatient Clinic, Cairo University, Egypt.Participants: Fifty-two men with post-COVID-19 syndrome were allocated randomly to the study and control groups.Intervention: The study group underwent diaphragm release plus inspiratory muscle training, whereas the control group received inspiratory muscle training only.Outcome measures: All patients were assessed with the following measures at baseline and 6 weeks postintervention: maximum static inspiratory pressure for inspiratory muscle strength, peripheral arterial blood pressure, Modified Medical Research Council scale for dyspnoea, Fatigue Severity Scale, serum lactate level, and 6-min walk test distance for aerobic performance.Results: All outcome measures showed a significant improvement in favour of the study group (p < 0.001) over the control group. However, maximum static inspiratory pressure increased significantly, by 48.17% (p < 0.001) in the study group with no significant change in the control group.Conclusion: Addition of manual diaphragm release to an inspiratory muscle training programme potentiates the role of inspiratory muscle training in the management of men with symptomatic post-COVID-19 syndrome.

Tracheal stenosis (TS) is abnormal tracheal lumen narrowing that can impair sufficient airflow and cause severe morbidity. Any level of the trachea can be affected from the cricoid cartilage to the main carina.TS may be congenital or idiopathic but most commonly is secondary to a variety of pathologies including tracheal trauma, malignancy, extrinsic compression or iatrogenic. Endotracheal intubation and tracheostomy are considered the most common causes of TS. 1 Historically, surgical management has been the mainstay of treatment in such cases, while endoscopic procedures are often viewed as a bridge to definitive surgical intervention either in simple stenosis or in high-risk patients. However, with the recent advances in the field of interventional pulmonology, definitive management of TS using multiple endoscopic methods became increasingly common especially in patients deemed non-operable. 2 We aimed to prospectively investigate the role of bronchoscopic management either by mechanical dilatation and

Background Depression is classified as a mood disorder. It may be described as feelings of sadness, loss, or anger that interfere with a person’s everyday activities. Nowadays, we are in COVID-19 pandemic. From practice after COVID-19 illness resolves, some of the recovering patients return back smoothly to their pre-illness life. Others experience different mood changes. Anxiety and depression are the most common. Those patients with improving general health, radiology, and oxygenation have different somatic complaints such as sensation of dyspnoea. Psychological support and psychiatric evaluation can help them to overcome this situation and get rid of dyspnoea sensation. This work aimed to evaluate the relation between COVID-19 survivors and depression and to how extent this could affect functional status of the study participants. Results This work recruited 102 adult patients as a sample of Egyptians who were positive PCR for SARS-COV2, turned negative and free of symptoms for 1 month or more which include physicians, nurses, employees, and literate health care workers of Ain Shams University hospitals attending chest outpatient clinic for follow-up. The majority were 47.1% in age group (35–55 years), sixty two (60.8%) participants were females, 74.5% had high education, and 24.5% were smokers. The most frequent symptom reported by study participants as the most annoying COVID-19 symptom was fever (32.4%). Beck depression inventory score showed that 59 (57.8%) participants had no depression, 24 (23.5%) had mild depression, 16 (15.7%) had moderate depression, and only 3 (2.9%) participants had severe depression. Logistic regression analysis was done to measure effect of steroid use and grade of dyspnoea on development of moderate or severe post-COVID depression and showed that higher grades of dyspnoea were associated with higher probability of development of moderate or severe post-COVID depression (p value < 0.05). Conclusion As predicted, COVID-19 survivors presented a high prevalence of psychiatric sequelae. Age, sex, and education level were important association factors. Higher educational level was associated with higher score of depression due to increased awareness of the current pandemic issue. Steroids’ use was proposed as a cause of depression since the majority of moderate or severe depression group were on steroids. Higher grades of dyspnoea were associated with higher probability of development of moderate or severe post-COVID depression. It is suggested that COVID-19 survivors should be assessed, to properly diagnose and treat any psychiatric conditions, to reduce the disease burden.

Background Retinal and choroidal blood vessels are involved in many systemic diseases because they are complex vascular systems. Chronic obstructive pulmonary disease is considered as an inflammatory disease that affects many systems and coexists with several co-morbidities. Systemic inflammation and hypoxia affect the macula, choroid, retinal nerve fiber layer (RNFL), and blood vessels. Ocular co-morbidities have been detected in COPD patients. These can be quantitatively and qualitatively evaluated by Spectral Domain Optical Coherence Tomography (SD-OCT). Enhanced depth imaging OCT (EDI-OCT) is a quite new technique that utilizes light with an extended wavelength. An apparent relation has been found between chronic pulmonary disease and low corneal endothelial cell density preoperatively. So this work aimed to assess the impact of COPD severity grading and oxygen saturation on retinal nerve fiber layer thickness and subfoveal choroidal thickness. Results This was a case-control study, recruited 50 COPD patients and another 50 healthy volunteers as a control group. Measuring the thickness of the RNFL (superior, inferior, nasal, and temporal) in the four quadrants as well as the subfoveal choroidal thickness was done to both groups. The RNFL thickness in all quadrants and the SFCT in the COPD group were statistically significantly thinner in comparison to the control group. The RNFL thickness (mean) was 79.16 ± 10.49 μm compared to 96.30 ± 4.66 μm in the control group (p value 0.001). The SFCT (mean) was 213.12 ± 25.61 μm compared to 354.62 ± 53.82 μm in the control group (p value 0.001). The degree of thinning of the RNFL (superior, inferior, and temporal) and the SCFT was related to COPD (GOLD) stages severity (p value 0.001). Nasal RNFL was thinned out in all stages of COPD (GOLD) but with no statistical significance (p value 0.264). Conclusion The choroid and retina seem to be of the affected tissues during the progressive inflammatory course of COPD. Ocular pathologies should be evaluated in patients with systemic hypoxia. The eye examination for COPD patients can be carried out via a non-invasive procedure such as the OCT and the changes in the RNFL and SFCT thickness could be used as indicators for the severity of COPD.

Patients with coronavirus disease-19 (COVID-19) present as mildly, moderately, or severely and critically ill. Cytokine storm is responsible for fatal pneumonia and acute respiratory distress syndrome. Interferon-γ-induced protein-10 (IP-10) and chemokine ligand-7 (CCL-7) are chemokines that play a role in the chemotaxis of inflammatory cells and the release of pro-inflammatory cytokines. In this study, we assessed the serum levels of IP-10 and CCL-7 chemokines in COVID-19 patients and their correlation with disease severity and prognosis. The serum levels of CCL-7 and IP-10 were assessed in 67 COVID-19 patients and 10 healthy controls. Serum samples were collected and examined for these two markers using direct enzyme-linked immunosorbent assay. Patients were divided into two groups according to their disease severity. Serum levels of the test markers were compared between patients and controls, and between patients with different disease severities and correlated with other clinical and laboratory parameters. CCL-7 and IP-10 levels were significantly higher in patients than in controls and in severe than in mild/moderate cases. The receiver operating characteristic curve analysis of the two markers showed better performance of the combined markers as predictors of disease severity (area under the curve = 0.792). The results of our study suggest a potential role of IP-10 and CCL-7 as predictors of COVID-19 severity.